A Tiered Model for Global Neurosurgery Treating to Transform

Access to neurosurgical care remains extremely limited across low-resource settings, where treatable conditions such as infant hydrocephalus, traumatic brain injury, and CNS infections continue to cause preventable mortality and disability. This report presents a tiered development model designed to move health systems from total dependence to increasing levels of autonomy through progressive clinical, infrastructural, and educational milestones. Drawing on more than a decade of experience in Zanzibar, the model demonstrates how targeted investment in equipment, treatment capacity, and long-term training can transform a non-existent service into a regional reference center. Each level builds on the previous one, ensuring safe growth, strengthening local teams, and expanding access to life-saving neurosurgical care in a sustainable, context-adapted manner.